MATERNAL AND CHILD H UGANDA Embolism - …

1 MATERNAL and CHILD Health: UGANDA Page 1 UGANDA EXPERIENCES SLOW PROGRESS IN MATERNAL HEALTH MATERNAL morbidity and mortality relate to illness or death occurring during pregnancy or childbirth, or within two months of the birth or termination of a pregnancy. The fifth Millennium Development Goal (MDG) aims to reduce the MATERNAL mortality ratio by 75% between 1990 and 2015. In UGANDA , MATERNAL mortality remains high at 440 MATERNAL deaths per 100,000 live births1. For every MATERNAL death in UGANDA , at least six survive with chronic and debilitating ill health2.

2 Most MATERNAL deaths are due to causes directly related to pregnancy and childbirth unsafe abortion and obstetric complications such as severe bleeding, infection, hypertensive disorders, and obstructed labor3. Others are due to causes such as malaria, diabetes, hepatitis, and anaemia, which are aggravated by pregnancy (Figure 1). Figure 1: Leading causes of MATERNAL mortality: Regional estimates for sub-Saharan Africa (1997-2007)3. Haemorrhage34%Hypertension19%Indirect17% Other direct11%Abortion9%Sepsis9%Embolism1% MATERNAL AND CHILD HEALTH: UGANDA MATERNAL and CHILD Health: UGANDA Page 2 Data on MATERNAL morbidity in UGANDA is limited as 62% of women are delivering outside health facilities, without skilled care2.

3 Health systems challenges and poor social determinants of health slow the improvement of women s and children s health. Difficult access to quality services, a shortage of trained and motivated health care professionals and shortages of essential drugs and medicines contribute to high mortality and morbidity rates. Coverage of interventions is also inequitable in UGANDA . While approximately 94% of women giving birth received some antenatal care by a healthcare professional (doctors, nurses and midwives), in rural areas, only 36% of women delivered in a health facility compared to 79% in urban areas.

4 Similarly, women in the highest wealth quintile were 3 times more likely to deliver in a health facility than women in the lowest wealth quintile4. Together with income, education also plays a major role in determining MATERNAL health outcomes, including fertility rates, access to family planning, and antenatal coverage. Women in UGANDA with higher education are much more likely to deliver in a health facility than women with no education (75% vs. 25%). Restrictive abortion legislation also contributes substantially to MATERNAL mortality and morbidity in Uganda5.

5 UGANDA RANKED 19TH GLOBALLY IN UNDER-5 DEATHS Over 7 million children globally under-5 years of age die each year mainly from preventable and treatable conditions. Pneumonia, diarrhoea and malaria remain the leading cause of CHILD mortality, and under nutrition contributes to more than one-third of all deaths. Millions of children could be saved each year if proven interventions such as antibiotics for pneumonia, oral rehydration therapy for diarrhoea, and the provision of insecticide treated nets (ITNs) to prevent malaria, were universally available.

6 While infant and under-5 mortality rates have declined from 186 deaths per 1000 in 1990 to 135 in 2008, UGANDA is not on track to meet MDG 4 to reduce the under-5 mortality by two thirds between 1990 and 20156 and is ranked 19th country globally with the highest under-5 deaths7. Nearly 21% of under-5 deaths occurred during the neonatal period (Figure 2); 30% of all neonatal deaths are due to preterm births and asphyxia, followed by severe infections. Just over 75% of under-5 deaths are post-neonatal7 and leading causes of these deaths are malaria, diarrhoea, and pneumonia (Figure 2).

7 In 2009, UGANDA also experienced over 38,000 stillbirths8. The probability of dying between the first and fifth birthday for rural infants is 45% higher than for urban infants4. There are persistently high rates of malnutrition in UGANDA : 38% of children under 5 suffer from chronic malnutrition (stunting), 16% from underweight and 6% from acute malnutrition3, 9. Figure 2: Under-5 mortality by cause of death in UGANDA (2008)3. Other13%Injuries4%HIV/AIDS4%Diarrhoeal diseases (post neonatal)14%Neonatal21%Diarrhoea14%Malar ia19%Pneumonia11% Figure 3: Under-5 mortality in UGANDA by background characteristics (1996-2006)4.

8 1141531691021721080204060801001201401601 80 UrbanMotherwith noeducationLowestwealthquintile Socioeconomic status is a key determinant of survival. Under-5 children in the lowest wealth quintile in UGANDA are nearly times more likely to die than those in the highest quintile8, 10. The biggest differential in the under-5 mortality ratio in UGANDA is related to mother's education (Figure 3). Water supply, sanitation and hygiene (WASH)-related diseases and associated conditions ( , anemia, dehydration and malnutrition) are a leading cause of under-5 hospitalization and mortality.

9 Poor sanitation coupled with unsafe water sources has contributed significantly to the disease burden in UGANDA , including dysentery, diarrhoea and typhoid fever where improved sanitation facilities and access to water supply remain poor. Only 48% of households have improved sanitation facilities while only 67% have access to improved drinking water sources4. Although UGANDA has launched broad reform, efforts around water and sanitation will need to be stepped up considerably in order to reach the MDG targets by 201511.

10 MATERNAL and CHILD Health: UGANDA Page 3 GOVERNMENT COMMITMENT TO WOMEN AND CHILD HEALTH The Constitution of UGANDA sets out the State s duty to ensure all Ugandans enjoy access to health services and to take all practical measures to ensure the provision of basic medical services to the population. However, there is no specific provision on the right to health12. The national Safe Motherhood Program (SMP) has guided the promotion of MATERNAL health in UGANDA . As part of this program, a number of initiatives were established in the last decade, including building a supportive community network of traditional birth attendants (TBAs) as a backup for a modern MATERNAL health system, and interventions to forecast high-risk obstetric events and strengthen referral systems.